Definitions of sexual sadism in ICD-10 and DSM-IV will be presented as well as the historical routes of the concept. Today studies on differently selected clinical samples reveal a different distribution of sexual sadism versus masochism with masochism prevailing in general especially outpatient psychiatric facilities, and sadism prevailing in forensic settings, thus corroborating the concept of two separated diagnoses sadism versus masochism. In forensic settings the diagnosis of a sadistic character disorder (sadistic personality disorder [SPD] according DSM-III-R) is found to a much higher degree than in other clinical samples (50-fold). Our own follow-up study on a forensic sample implies that sadism as a paraphilia is of relevance for relapse-rates of sex-offenders. Symptoms of SPD can be combined with sexual sadism, or occur independently. This may corroborate arguments in favor of a dimensional concept of sexual sadism. Symptoms of SPD may then be a sign of generalization of sadistic traits at least in some cases. A concept of two factors contributing to sadistic pleasure is suggested, one taking the aspect of bodily gratification by sexual-aggressive stimuli as decisive, and the other taking inner representation of hostile objects into consideration (stressing the antisocial-anger-rage aspect).
